Provider Demographics
NPI:1639703879
Name:IMANI MENTAL HEALTH SERVICES LLC
Entity Type:Organization
Organization Name:IMANI MENTAL HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOANNE
Authorized Official - Middle Name:C
Authorized Official - Last Name:ROP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-419-5096
Mailing Address - Street 1:18672 E OLD BEAU TRL
Mailing Address - Street 2:
Mailing Address - City:QUEEN CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85142-3521
Mailing Address - Country:US
Mailing Address - Phone:515-419-5096
Mailing Address - Fax:
Practice Address - Street 1:18672 E OLD BEAU TRL
Practice Address - Street 2:
Practice Address - City:QUEEN CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85142-3521
Practice Address - Country:US
Practice Address - Phone:515-419-5096
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-26
Last Update Date:2022-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty